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<html class="no-js">
    <head>
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        <title>添加患者</title>

        
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        <link rel="stylesheet" type="text/css" href="../css/mian.css" />
        <link rel="stylesheet" type="text/css" href="../css/addpatient.css" />
        <style type="text/css">
            .am-form-group {
                margin-left: -15px;
                margin-right: -15px;
            }

            .suit-box {
                padding: 0 15px;
            }
        </style>
    </head>
    <body>
        <div class="header clearfix">
            <div class="nav">
                <ul>
                    <li>患者</li>
                    <li>咨询</li>
                </ul>
            </div>
            <div class="fast-search-box">
                <input class="fast-search" type="text" placeholder="快速搜索...">
            </div>
        </div>
        <div class="content">
            <div class="pantient-message-container">
                <h1 class="pantient-message">待生成患者信息</h1>
            </div>
            <div class="am-form mian-table create-patient-message">
                <div class="form-hd">
                    <ul class="patient-message-fill-list message-nav">
                        <li class="item">患者资料</li>
                        <li class="item">家长资料</li>
                        <li class="item active">临床信息</li>
                        <li class="item">患者封面照</li>
                        <li class="item">照片</li>
                        <li class="item">X光</li>
                        <li class="item">口扫数据</li>
                    </ul>
                </div>
                <div class="message-table-container">
                    <div class="message-table-tbody">
                        <form class="table-data clinical-data" data-index="2">
                            <div class="form-hd">主诉信息 : </div>
                            <div class="suit-box am-form-group">
                                <div  class="item-hd required"  v-for="item in list "  :key="item.id" >患者主诉</div>
                                <textarea  id="text1" rows="5" cols="" name="XBShzxx" placeholder="(例如: 上前牙前突4年要求治疗)"  v-model="maininfo" >{{item.maininfo}}</textarea>
                            </div>
                            <div class="form-hd">现病史/既往史</div>
                            <div class="am-form-group">
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd required">鼻咽部疾病</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSbyb" class="checkacc"
                                                    value="有">有
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSbyb" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd required">治疗动机</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSzldj" class="checkacc"
                                                    value="父母意愿">父母意愿
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSzldj" class="checkacc"
                                                    value="自身愿意">自身愿意
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd required">过敏史</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSgms" class="checkacc"
                                                    value="有">有
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSgms" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSgms" class="checkacc"
                                                    value="其他">其他
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd required">全身疾病</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSqsbs" class="checkacc"
                                                    value="有">有
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSqsbs" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd required">喂养方式</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSwyfs" class="checkacc"
                                                    value="母乳">母乳
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSwyfss" class="checkacc"
                                                    value="奶瓶">奶瓶
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSwyfss" class="checkacc"
                                                    value="混合">混合
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd required">家族遗传史</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSjzycs" class="checkacc"
                                                    value="反颌">反颌
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSjzycs" class="checkacc"
                                                    value="小下颌畸形（鹰嘴）">小下颌畸形（鹰嘴）
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSjzycs" class="checkacc"
                                                    value="其他"> 其他
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd required">不良习惯</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="XBSblxg" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSblxg" class="checkacc"
                                                    value="打鼾">打鼾
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSblxg" class="checkacc"
                                                    value="吮指">吮指
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSblxg" class="checkacc"
                                                    value="咬物">咬物
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="XBSblxg" class="checkacc"
                                                    value="吮颊">吮颊
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">不良习惯发现及持续时间</div>
                                        <textarea rows="5" cols="" name="XBSblxg" placeholder="（例如：请描述不良习惯发现及持续时间）"></textarea>
                                    </div>
                                </div>
                            </div>
                            <div class="form-hd">面部检查</div>
                            <div class="am-form-group">
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">正面观 ：</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCzm" class="checkacc" value="左右基本对称">左右基本对称
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCzm" class="checkacc" value="左右不对称">左右不对称
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">侧貌</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCcm" class="checkacc" value="直">直
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCcm" class="checkacc" value="凹">凹
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCcm" class="checkacc" value="凸">凸
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">上唇</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCsc" class="checkacc" value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCsc" class="checkacc" value="过短">
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">鼻唇沟</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCbcg" class="checkacc" value="锐角">锐角
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCbcg" class="checkacc" value="钝角">钝角
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">唇肌</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCcj" class="checkacc" value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCcj" class="checkacc" value="紧张">紧张
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">颏肌</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCkj" class="checkacc" value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCkj" class="checkacc" value="紧张">紧张
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">下颌骨</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCxhg" class="checkacc" value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCxhg" class="checkacc" value="左偏">左偏
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCxhg" class="checkacc" value="右偏">右偏
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">呼吸方式</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJChxfs" class="checkacc" value="鼻呼吸">鼻呼吸
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJChxfs" class="checkacc" value="口呼吸">口呼吸
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">吞咽方式</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCtyfs" class="checkacc" value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="MBJCtyfs" class="checkacc" value="婴儿式吞咽">婴儿式吞咽
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="form-hd">口内软组织及功能检查</div>
                            <div class="am-form-group">
                                <div class="item-list">
                                    <div class="item clearfix">
                                        <div class="col-sm-4">
                                            <div class="item-hd">开口度</div>
                                            <input type="text">
                                        </div>
                                        <div class="col-sm-4">
                                            <div class="item-hd">开口型</div>
                                            <input type="text">
                                        </div>
                                        <div class="col-sm-4">
                                            <div class="item-hd">闭口型</div>
                                            <input type="text">
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">关节弹响</div>
                                        <div class="item-content middle">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZgjtx" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZgjtx" class="checkacc"
                                                    value="左有">左有
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZgjtx" class="checkacc"
                                                    value="右有">右有
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZgjtx" class="checkacc"
                                                    value="左右有">左右有
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">颞下颌关节</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZnxh" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZnxh" class="checkacc"
                                                    value="左异常">左异常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZnxh" class="checkacc"
                                                    value="右异常">右异常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZnxh" class="checkacc"
                                                    value="左右都异常">左右都异常
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">颌干扰</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZhgr" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZhgr" class="checkacc"
                                                    value="有">有
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">舌体大小</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZstd" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZstd" class="checkacc"
                                                    value="大">大
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZstd" class="checkacc"
                                                    value="齿痕">齿痕
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">舌体位置</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZstwz" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZstwz" class="checkacc"
                                                    value="偏前">偏前
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZstwz" class="checkacc"
                                                    value="偏下">偏下
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">唇系带附着</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZcxd" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZcxd" class="checkacc"
                                                    value="低">低
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">舌系带</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZsxd" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZsxd" class="checkacc"
                                                    value="低">短
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item">
                                            <div class="item-hd">扁桃体</div>
                                            <div class="item-content">
                                                <label class="m-radio">
                                                    <input type="radio" name="RZZbtt" class="checkacc"
                                                        value="Ⅰ">Ⅰ
                                                    <span></span>
                                                </label>
                                                <label class="m-radio">
                                                    <input type="radio" name="RZZbtt" class="checkacc"
                                                        value="Ⅱ">Ⅱ
                                                    <span></span>
                                                </label>
                                                <label class="m-radio">
                                                    <input type="radio" name="RZZbtt" class="checkacc"
                                                        value="Ⅲ"> Ⅲ
                                                    <span></span>
                                                </label>
                                                <label class="m-radio">
                                                    <input type="radio" name="RZZbtt" class="checkacc"
                                                        value="正常">正常
                                                    <span></span>
                                                </label>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">其他</div>
                                        <input type="text" name="RZZqt">
                                    </div>
                                </div>
                            </div>
                            <div class="form-hd">错颌畸形检查</div>
                            <div class="am-form-group">
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">锁合牙</div>
                                        <input type="text" name="CHJXshy" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">扭转牙</div>
                                        <input type="text" name="CHJXnzy" />
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">融合牙</div>
                                        <input type="text" name="CHJXrhy" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">畸形中央尖</div>
                                        <input type="text" name="CHJXjxzy" />
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">乳牙缺失牙</div>
                                        <input type="text" name="CHJXryqs" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">先天恒牙胚缺失</div>
                                        <input type="text" name="CHJXhyqs" />
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">多生牙</div>
                                        <input type="text" name="CHJXdsy" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">牙尖发育异常牙</div>
                                        <input type="text" name="CHJXycy" />
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">咬上颌腭部黏膜</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXysh" class="checkacc"
                                                    value="是">是
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXysh" class="checkacc"
                                                    value="否">否
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">牙周炎</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXyzyz" class="checkacc"
                                                    value="有">有
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXyzyz" class="checkacc"
                                                    value="无">无
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">冠根比≤1的牙</div>
                                        <input type="text" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">反颌下颌可退至切对切：</div>
                                        <div class="item-content middle">
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXqdq" class="checkacc"
                                                    value="是">是
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXqdq" class="checkacc"
                                                    value="否">否
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">上颌牙弓</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXshyg" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXshyg" class="checkacc"
                                                    value="狭窄">狭窄
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">下颌牙弓</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXxhyg" class="checkacc"
                                                    value="正常">正常
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="CHJXxhyg" class="checkacc"
                                                    value="狭窄">狭窄
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">磨牙关系左</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyz" class="checkacc"
                                                    value="Ⅰ">Ⅰ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyz" class="checkacc"
                                                    value="Ⅱ">Ⅱ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyz" class="checkacc"
                                                    value="Ⅲ"> Ⅲ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyz" class="checkacc"
                                                    value="无法确定">无法确定
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">磨牙关系右</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyy" class="checkacc"
                                                    value="Ⅰ">Ⅰ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyy" class="checkacc"
                                                    value="Ⅱ">Ⅱ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyy" class="checkacc"
                                                    value="Ⅲ"> Ⅲ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZmyy" class="checkacc"
                                                    value="无法确定">无法确定
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">尖牙关系左</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyz" class="checkacc"
                                                    value="Ⅰ">Ⅰ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyz" class="checkacc"
                                                    value="Ⅱ">Ⅱ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyz" class="checkacc"
                                                    value="Ⅲ"> Ⅲ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyz" class="checkacc"
                                                    value="无法确定">无法确定
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">尖牙关系右</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyy" class="checkacc"
                                                    value="Ⅰ">Ⅰ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyy" class="checkacc"
                                                    value="Ⅱ">Ⅱ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyy" class="checkacc"
                                                    value="Ⅲ"> Ⅲ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZjyy" class="checkacc"
                                                    value="无法确定">无法确定
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">前牙覆颌</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfh" class="checkacc"
                                                    value="Ⅰ">Ⅰ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfh" class="checkacc"
                                                    value="Ⅱ">Ⅱ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfh" class="checkacc"
                                                    value="Ⅲ"> Ⅲ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfh" class="checkacc"
                                                    value="无法确定">无法确定
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">前牙覆盖</div>
                                        <div class="item-content">
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfg" class="checkacc"
                                                    value="Ⅰ">Ⅰ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfg" class="checkacc"
                                                    value="Ⅱ">Ⅱ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfg" class="checkacc"
                                                    value="Ⅲ"> Ⅲ
                                                <span></span>
                                            </label>
                                            <label class="m-radio">
                                                <input type="radio" name="RZZqyfg" class="checkacc"
                                                    value="无法确定">无法确定
                                                <span></span>
                                            </label>
                                        </div>
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">

                                    </div>
                                </div>
                            </div>
                            <div class="form-hd">特殊检查</div>
                            <div class="am-form-group">
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">CBCT线检查日期</div>
                                        <input type="text" name="TSJCrq" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">CBCT线检查诊断</div>
                                        <input type="text" name="TSJCzd" />
                                    </div>
                                </div>
                                <div class="item-list">
                                    <div class="item">
                                        <div class="item-hd">颞颌关节检查日期</div>
                                        <input type="text" name="TSJCnhsq" />
                                    </div>
                                    <div class="item">
                                        <div class="item-hd">颞颌关节检查诊断</div>
                                        <input type="text" name="TSJCnhzd" />
                                    </div>
                                </div>
                            </div>
                            <div class="form-hd">医生诉求及设计思路</div>
                            <div class="suit-box am-form-group">
                                <textarea rows="5" cols="" name="TSJCyssq" placeholder="例如: 医生需要***"></textarea>
                            </div>
                        </form>
                    </div>
                </div>
                <div class="form-foot clearfix">
                    <div class="ch">
                        <div class="next-step">下一步</div>
                        <div class="pre-step">上一步</div>
                    </div>
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